MRS联合VBM对首发抑郁症患者海马代谢和结构的研究

李宗鸿 胡晓 王晓 王纯 胡君 李成林 肖朝勇 刘献伟

【摘要】 目的：运用多体素三维磁共振波谱（3D-1H-MRS）和基于体素的形态测量（voxel based morphometry，VBM）方法分析首发抑郁症患者双侧海马代谢物改变和结构体积变化特点，评价海马1H-MRS及体积变化在首发抑郁患者早期诊断的应用价值。方法：测量40例首发抑郁患者和20例健康者双侧海马体积及肌酸（Cr）、N-乙酰天门冬氨酸（NAA）、胆碱（Cho）峰下面积，计算出NAA/Cr、Cho/Cr比值，并进行统计学分析。结果：首发抑郁组右侧海马NAA/ Cr、Cho/Cr及Cho值低于对照组，差异均有统计学意义（P<0.05）;两组其余代谢指标比较差异无统计学意义（P>0.05）;首发抑郁组双侧海马体积与健康组比较差异无统计学意义（P>0.05）。结论：多体素3D-1H-MRS可为临床医生早期诊断首发抑郁提供参考。

【关键词】 首发抑郁症 磁共振波谱 形态测量法 海马

doi：10.14033/j.cnki.cfmr.2019.28.026 文献标识码 B 文章编号 1674-6805（2019）28-00-03

Metabolism and Structure of Hippocampus in First-episode Depressive Patients by MRS Combined with VBM/LI Zonghong， HU Xiao， WANG Xiao， WANG Chun， HU Jun， LI Chenglin， XIAO Chaoyong， LIU Xianwei. //Chinese and Foreign Medical Research， 2019， 17（28）： -65

[Abstract] Objective： To analyze the metabolic characteristics and the structure changes of hippocampus by 3D multivoxel proton magnetic resonance spectroscopy （3D-1H-MRS） and voxel based morphometry （VBM） in first-episode depression. To evaluate the value of 1H-MRS and volume changes in hippocampus in early diagnosis of first-episode depression. Method： A total of 40 depressive patients and 20 normal controls were assessed in this study. NAA、Cr and Cho peak area were detected in different areas， the volume of hippocampus， and NAA/Cr， Cho/Cr ratio were calculated and analyzed statistically. Result： The first-episode depressive group had significantly lower Cho value， NAA/Cr and Cho/Cr ratio in right hippocampus than health group， the differences were statistically significant （P<0.05）. No significant differences were found in other metabolic values between the two groups （P>0.05）. There were no significant differences in the volume of hippocampus between the first-episode depressive group and the health group （P>0.05）. Conclusion： Multivoxel 3D-1H-MRS can provide reference for clinicians to early diagnosis of depression.

[Key words] First-episode depressive Magnetic resonance spectroscopy Voxel based morphometry Hippocampus

First-authors address： Nanjing Brain Hospital of Nanjing Medical University， Nanjing 210029， China

抑郁症（major depression，MD）以情感低落、思维迟缓及言语动作减少、迟缓为典型症状，其发病机制仍未完全阐明[1-3]。海马对学习、记忆和情绪等脑高级功能活动有重要影响，许多神经和精神疾病都会出现海马代谢和体积的改变[4-5]。然而对于首发MD患者海马代谢功能和结构的研究尚存在不一致的结论。笔者联合MRS和VBM方法对首发MD患者海马代谢功能和结构改变进行研究，以便为抑郁症的临床诊断提供参考，并为此疾病的病因学探讨提供线索，现报告如下。

1 资料与方法

1.1 一般資料

选取40例2011年-2014年在笔者所在医院就诊的首发抑郁障碍（major depressive disorder，MDD）首发MD患者为首发抑郁组，符合CCMD-3抑郁发作和DSM-IV首发抑郁症诊断标准，24项汉密尔顿抑郁量表（Hamilton rating scale for depression，HAMD）≥35分，均为右利手，排除神经系统和其他精神障碍性疾病、严重躯体疾病、药物和/或酒精依赖及MRI检查有禁忌者。健康……